1. Field of the Invention
The present invention pertains to suturing instruments and, more particularly, to instruments for arthroscopic suturing of tissue within the body without requiring open surgery.
2. Discussion of the Prior Art
Arthroscopic surgery, which is used herein to encompass surgery on various parts of the body requiring only small incisions or portals for insertion of diagnostic and surgical instruments manipulated externally of the body as well as such surgery performed on joints, is preferable over open surgery to avoid the trauma associated with large incisions as well as the hospitalization and prolonged recovery periods required with open surgery and is used whenever possible to achieve the same results as open surgery without the disadvantages thereof. Arthroscopic techniques include internal viewing for diagnosis and identification of problems as well as surgical operations such as meniscus removal or repair, shaving of irregular, roughened patella and other surfaces and articular surface smoothing. While many surgical operations that previously required open surgery can now be performed by arthroscopic surgery, there remain operations that still require open surgery due to the need for direct suturing, such as major ligament repair and cartilage repair.
Albright et al U.S. Pat. No. 4,493,323, and Mulhollan et al U.S. Pat. Nos. 4,602,635 and 4,621,640 are representative of prior art instruments for internal suturing without requiring open surgery; however, such instruments have the disadvantages of requiring multiple instrument manipulation and movement of needles carrying sutures entirely through tissue to be sutured. The instrument of the Albright et al patent includes a pair of needles forced outwardly through the end of a tube by a plunger to penetrate and extend through the tissue to be sutured and through the skin to permit the needles to be grasped by the surgeon and pulled to position a suture thread loop attached to the needles. The instrument of the Mulhollan et al Pat. No. 4,621,640 includes a curved needle carried by a pivotal head movable to cause the needle to be set in the tissue to be sutured, the needle then being released and the instrument withdrawn to allow insertion of another instrument to pull the needle through. The Mulhollan et al Pat. No. 4,602,635 relates to an instrument for tying knots in sutures in a manipulation area external of the body after the sutures are sewn through the tissue and then pushing the knots into place adjacent the tissue.
Drake et al U.S. Pat. No. 919,138, Violante U.S. Pat. No. 3,840,017, Fukuda U.S. Pat. No. 4,224,947, and Nastari et al U.S. Pat. No. 4,643,178 are representative of prior art suturing instruments wherein sutures are passed through hollow needles after the needles penetrate through tissue to be sutured, such suturing instruments having the disadvantage of requiring grasping of the suture material and, thus, being useful only in open surgery and not in arthroscopic surgery.
Pilling et al U.S. Pat. No. 1,815,725, Johnson U.S. Pat. No. 3,470,875, Schweizer U.S. Pat. No. 3,842,840, Bassett U.S. Pat. No. 3,946,740 and Johnson et al U.S. Pat. No. 4,164,225 are representative of prior art suturing instruments having pivoted, scissor-like arms with a needle forced through the end of one arm, through tissue to be sutured and into the end of the other arm where the suture is grasped or clamped, such suturing instruments having the disadvantage of being of a structural design to prevent their use in arthroscopic surgery.
Donohue U.S. Pat. No. 4,312,337 discloses an instrument for drilling and wiring bones having scissor-like arms carrying cannula sections through which a wire is passed, the wire being cut and tied after the cannula sections are withdrawn. The scissor-like structure permits this instrument to be used only in open surgery and not in arthroscopic surgery.
Another scissor-like instrument for suturing is disclosed in Freda et al U.S. Pat. No. 4,596,249, the instrument having a hook passing through tissue to engage a suture and pull it back through the tissue, the instrument not being useful in arthroscopic surgery due to its scissor-like structure.